The Open Communication Journal, 2011, 5, 1-10
1
Open Access
Weight-Related Stigma as a Predictor of Self-Disclosure Patterns in
Women
Denise M. Polk*,1 and Gwen A. Hullman2
1
West Chester University, Main Hall, 5th Floor, West Chester, PA 19383, USA; 2United States, University of Nevada,
Reno MS 0229 Reno, NV 89557, United States
Abstract: Research suggests that overweight/obese people face stigma. A measure of weight-related stigma was
developed, adapted from the HIV stigma measure (Berger, Ferrans, & Lashley, 2001). A CFA confirmed the measure’s
internal consistency. Using privacy management theory as a framework, participants (N = 199) completed a self-report
survey that included a hypothetical conversational partner profile. Regression analysis and independent sample t-tests
helped answer hypotheses about the ways weight-related stigma affect disclosure as well as how weight affects selfdisclosure and attraction. Attraction to partner and weight-related stigma significantly predicted overall self-disclosure
ratings. Implications for obesity research, privacy management, and stigma are discussed.
Keywords: Stigma, obesity, self-disclosure, health.
INTRODUCTION
Communication Privacy Management Theory
Obesity in the United States is on the rise (Center for
Disease Control and Prevention; CDC (2009a). According to
the CDC (2009a), the terms overweight and obesity are
labels for weight ranges greater than what is generally
considered healthy for a given height. In 2008, only
Colorado had a prevalence of obesity less than 20%, and 32
states had a prevalence equal to or greater than 25% (CDC,
2009b). People whose body mass index (BMI) exceeds 25
are labeled as overweight, and people whose BMI exceeds
30 are considered obese (CDC, 2009a). Some people,
however, use the terms interchangeably (Smith, Schmoll,
Konik, & Oberlander, 2007). For the purposes of this study,
we distinguished only between people in the “normal”
weight range versus people who would be considered
“overweight/obese” by these criteria.
Communication privacy management theory (Petronio,
1991) considers the role of self-disclosure, which is defined
as the personal information people verbally reveal about
themselves (Delerga, Metts, Petronio, & Margulis, 1993).
Petronio developed communication privacy management
theory to explain the way people regulate the flow of private
information. Communication privacy management has been
used in a wide variety of contexts such as friendships
(Wilson, Roloff, & Carey, 1998), family communication
(Afifi, 2003; Caughlin, Huston, & Houts, 2000; Thorson,
2009), computer-mediated communication (Metzger, 2007),
living in a nursing home (Petronio, & Kovach, 1997) and
disclosing HIV status (Greene, Derlega, Yep, & Petronio,
2003).
Stigma
Attitudes about people who are obese largely are
negative. Negative and socially undesirable attributes that
people assign (Goffman, 1963) to people who are obese
include: (a) anti-fat bias where existing negative attitudes
towards people who are obese often result in discriminatory
acts and (b) obesity stigma which is the resulting social
disapproval tied to such stereotypes (Lewis, & Van
Puyembroeck, 2008). As a result, stigma is an issue of social
injustice and disempowerment (Scheyett, 2005) for which
people who are obese might seek support -- requiring
interpersonal interaction and most likely disclosure about the
stigmatized experience.
*Address correspondence to this author at the West Chester University,
Main Hall, 5th Floor, West Chester, PA 19383, USA; Tel: 610-436-2180;
Fax: 610-436-3046; E-mails: [email protected]; [email protected]
This project was partially supported through a University of Nevada
College of Liberal Arts Scholarly and Creative activities Grant.
1874-916X/11
Communication privacy management differs from earlier
studies on self-disclosure (e.g., Jourard, 1964). First,
whereas Jourard (1964) suggested that more disclosure is
desirable, communication privacy management considers
that people value disclosure, but they also value privacy and
recognize serious risks associated with disclosure (Morr,
Serewicz, & Petronio, 2007). Competent self-disclosure is
dialectical because it involves communicators balancing both
interactants’ needs for intimacy and privacy (Dindia, 1994).
Petronio’s (1991) tenets of communication privacy
management theory also differ from Jourard because they
separate the ideas of disclosure and intimacy development
(Morr, Serewicz, & Petronio, 2007). Communication privacy
management also involves several layers that consider
beliefs about private information and: ownership, control,
boundaries, and the consequences of making another person
a co-owner of it.
Rationale
Communication privacy management provides a helpful
framework in which to study how weight-related stigma
2011 Bentham Open
2 The Open Communication Journal, 2011, Volume 5
affects women’s self-disclosure. First, although some
research suggests individuals are rewarded for engaging in
high levels of self-disclosure (Barker & Benton, 1994),
studies using privacy management have found people may
be punished for their self-disclosure. Women may be
susceptible to the privacy-disclosure dilemmas associated
with weight-related stigma because women provide more
personal self-disclosure than men, and they are also more
likely to be the target of self-disclosure (Dindia & Allen,
1992; Dolgin, Meyer, & Schwartz, 1991). In addition,
women tend to be held to stricter standards regarding their
weight (Blaine & Williams, 2004). Relatively little is known
about disclosure decisions made by people who are obese.
The weight of both conversational partners can influence
conversation. For example, both overweight and normal
weight nurses expressed concern about offering advice to
patients about eating better and exercising more (Brown &
Thompson, 2007). Nurses with a high BMI expressed
concern about being judged by patients or by being seen as
poor role models whereas nurses with a low BMI feared they
would be perceived as unauthentic. In addition some people
have distinct terminology preferences when discussing
weight-related issues (Wadden & Didle, 2003).
Bliss (2006) argued that attitudes surrounding obesity
lead to less discussion of women’s weight-related stigma
experiences and perhaps a greater sense that they are the
only ones “failing” at attempts to lose weight. Whereas
people commonly discuss diet strategies and success rates,
“… it is unusual to hear obese people discuss what it is like
for them to be overweight, and still more rare to hear them
describe their weight control failures” (Rogge, Greenwald, &
Golden, 2004, p. 301). This appears to be important for
buffering weight-related stigma. For example, Puhl and
Brownell (2003) suggested that discussing stigmatized
experiences might reduce stigma because people question
social consensus about bias. In addition, invoking empathy
from discrimination stories reduced bias against obesity
(Teachman, Gapinski, Brownell, Rawlins, & Jeyaram, 2003).
Tucker, Martz, Curtin, and Bazzini (2007) used confederates
in mixed BMI female dyads to engage in “fat talk” and
found that conversational partners followed the norm of
reciprocity by attempting to match each other’s body
presentation style, but the discussion of weight might have
been avoided by some conversational partners had not the
confederate initiated it.
People have multiple, and often conflicting, goals
surrounding self-disclosure (Dindia, 1994), and they use past
experiences to predict potential future outcomes.
Considering the mixed and negative messages about people
who are obese, talking about weight is face-threatening.
Dindia’s ideas about the intrapersonal relationship between
self-disclosure and stigma are intriguing. Stigmatized
individuals engage in a dialectical process whereby they
cyclically engage in a need to preserve face so as not to
induce shameful feelings and in a need to confide in others
to seek help (Limandri, 1989). Women who are obese
constantly may feel a loss of face. As a result, these women
experience a greater number of situations where they are
unsure of what type of identity to project.
In addition, according to the premises of communication
privacy management, people are expected to learn self-
Polk and Hullman
disclosure norms through socialization (Morr Serewicz &
Petronio, 2007). If women have been “punished” for their
weight-related disclosure in the past, the norm of reciprocity,
an overarching principle of face (Goffman, 1963), might
seem counterintuitive. This elicits privacy dilemmas
suggested by Petronio (2007) and may impact disclosure
decisions in order to serve as self-protection. Because people
who experience repeated stigma go to great lengths to avoid
situations that may induce stigma (Myers & Rosen, 1999)
the following hypothesis can be tested:
H1: Stigma will be a negative predictor of weight-related
disclosure made in conversation.
Gaining and giving social support often requires selfdisclosure. Moreover, effective support is related to effective
coping with weight-related stigma (Panchankis, 2007).
However, similar to communication privacy management
predictions regarding risks for both nondisclosure and
disclosure, people are aware of risks associated with
soliciting and giving support (Goldsmith, 2004). Effective
support is critical for effective weight management. Even
when people express desire to lose weight, they need
professional and social support to be successful (Bidgood &
Buckroyd, 2005). Ineffective support may contribute to the
onset of obesity and/or may worsen weight-related health
concerns (Okun & Keith, 1998).
Women tend to be the primary seekers of health
information for themselves and for other family members
(Warner & Procaccino, 2004; Wuest, 2000). Women also
use formal networks (e.g., doctors) as well as informal
networks, (e.g., other friends, often female) to seek healthrelated information (Harris & Dewdney, 1994). Because
people who are obese stigmatize excess weight as much as
people who are not overweight (Lewis & Van Puymbroeck,
2008; Schwartz, Vartanian, Nosek, & Brownell, 2006),
people who are obese develop very little sense of in-group
identity and support (Crandall, 1994; Crocker, Voelkl, Testa,
& Major, 1991). In addition, “obesity stigma-by-association”
may create the perception of support unavailability (Hebl &
Mannix, 2003). These missed opportunities to gain support
and to cope with stigma because of hesitation to engage in
weight-related self-disclosure result in limited or unavailable
access to other women as support resources. Derlega,
Lovejoy, and Winstead (1998) claimed that people with HIV
experience a tension between the wish to disclose
information in order to obtain support and the need to
conceal information to protect against discrimination,
rejection, and gossip. Obese women also may experience
similar tensions. Therefore, the following hypotheses test the
relationship between weight and self-disclosure:
H2: Participants in the “normal” weight category will be
less likely to make weight-related disclosures to overweight
conversational partners than to normal weight partners.
H3: Overweight participants will be less likely than
normal weight women to make weight-related disclosures to
conversational partners regardless of partner weight.
Communication privacy management suggests that
judgments about weight also impact other characteristics of
the target of disclosure which in turn impact disclosure. A
person’s appearance is especially important in the beginning
stages of a relationship (Rosenfeld, Stewart, Stinnett, &
Integration and Privacy
Jackson, 1999). Berg and Archer (1983) stated that “few
would contest the assertion that we disclose more to who we
like” (p. 269), and this makes sense since Broder (1982)
claimed that the relationship between liking and attraction
has received “widespread empirical support” (p. 303). Given
the tendency for people to rate “normal” weight people as
more attractive than people who are obese (Chen, 1997;
Knapp & Hall, 1997; Legenbauer, Vocks, Shäfer, SchüttStromel, Hiller, Wagner, & Vogele, 2009; Lin, 1998), we
expect that people would like more attractive targets more
and therefore disclose more information to them. As a result,
the following hypotheses will test attraction and weight and
disclosure:
H4: Regardless of participant weight, participants will
rate obese conversational partners as less attractive.
H5: Attraction to conversational partner will be a positive
predictor of the types of disclosure made in conversation.
Anti-fat bias not only predicts body image, but also may
predict the way individuals value themselves (Friedman,
Reichmann, Costanzo, Zell, Ashmore, & Musante, 2005).
There seems to be a more robust relationship between one’s
perceived weight and self-esteem than between one’s actual
weight and self-esteem (Miller & Downey, 1999).
Heightened self-awareness results from disclosure (Duval &
Wicklund, 1972), but increased self-awareness about
undesirable aspects of oneself also can negatively impact
self-esteem (Derlega et al., 1993). Thus, people might feel
worse about their weight when faced with decisions about
weight-related disclosure simply because it heightens their
awareness both of their personal feelings toward their weight
as well as the potential weight-related stigma. In this case,
self-esteem might mediate the perception that weight-related
topics should be avoided.
Stigma also impacts the relationship between obesity and
self-esteem. For example, heavy women exhibit internalized
weight bias (Durso & Latner, 2008). Ultimately, these selfesteem issues impact the ability to form close relationships
(Bidgood & Buckroyd, 2005), judgments about a person’s
worthiness as a partner (Boles & Latner, 2009), and
relational commitment (Boles & Latner, 2009).
People who are obese with lower self-esteem avoid
disclosing personal failures because of anticipated negative
consequences, whereas those with higher self-esteem
anticipate benefits to disclosing personal failures (Cameron,
Holmes, & Vorauer, 2009). Avoiding weight-related topics
could be explained by the finding that those who have lower
self-esteem tend to ruminate more about potential
detrimental consequences of self-disclosure (Afifi &
Caughlin, 2009). Although people who are obese experience
lower levels of self-esteem (Friedman, Reichmann,
Costanzo, Zell, Ashmore, & Musante, 2005), Puhl and Heuer
(2009) emphasized the need to investigate the influence of
stigma on self-esteem and to determine the impact of weightrelated stigma on interpersonal relationships. To find out
whether self–esteem influences what types of information
are disclosed in conversation, we ask:
The Open Communication Journal, 2011, Volume 5
3
subsequent test of actual interactions. Ultimately, the present
study can serve as a springboard to advance Petronio’s
(2007) goals for communication privacy management such
as determining how to change communication situations or
how to create a new system when people might face privacy
dilemmas, privacy violations, and trust mistakes.
Specifically, weight-related stigma might trigger people to
examine the relational consequences of talking about their
weight. This line of thinking would provide additional
support for one of Jacoby’s (2005) dimensions of stigma,
disruptiveness (the degree to which the stigma interferes
with social interactions). If women encounter disruption
caused by preoccupation with word choice and content of
self-disclosure of weight-related issues, then weight-related
stigma negatively affects and disrupts social interaction.
Thus, these situations might lead to rigid boundaries that
allow for little or no disclosure (Greene, 2000). Little or no
disclosure impedes relational development and social
support opportunities, which can result in social isolation.
Isolation is especially dangerous for those dealing with a
medical condition leading to possible health complications.
MATERIALS AND METHODOLOGY
Participants
Adult females (N = 199) were recruited to participate in
this study. Recruitment sites included a mid-size Eastern
university campus, a mid-size Western university campus,
and various groups in which women participate (for
example, a group of mothers of preschoolers). Participants
received $10 cash for their participation, which took
approximately 20 minutes of their time. The majority of
participants was Caucasian (n = 166; 83.4%). Other ethnic
groups included African American (n = 11; 5.5%), Latino
(n = 7; 3.5%), Asian American (n = 5; 2.5%), and “Other”
(n = 3; 1.5%). Participants’ ages ranged from 18 to 81 with a
mean age of 42 and standard deviation of 14.77. Some
women (n = 36; 18.1% belonged to a weight-related or
exercise group such as Weight Watchers (n = 13; 6.5%),
Curves (n = 13; 6.5%), Jazzercise (n = 8; 4.0%), or “Other”
(n = 9; 4.5%).
Procedures
Participants were recruited by placing flyers on campus
or locations where the groups met. When potential
participants contacted the investigators, they arranged a
mutually agreeable time to complete the survey. As part of
the information sheet, participants read, “This questionnaire
contains questions about your reactions to appearances,
conversational topics, and demographic information” and
“You are being asked to participate because you interact with
other people, and you create impressions of others.”
Participants completed questions about themselves, their
own experiences, and reactions to a hypothetical
conversational partner. To avoid fatigue or order effects, two
versions of the questionnaire packets were administered
randomly where items appeared in reverse order.
Instruments
RQ1: Is self-esteem a predictor of the types of disclosure
made in conversation?
Weight-related Stigma
Thus, preliminary findings about weight-related stigma
and disclosure decisions of women can be used to develop a
Berger et al. (2001) tested the HIV Stigma Scale. This
multidimensional measure consists of 40 Likert-type items
4 The Open Communication Journal, 2011, Volume 5
on four different factors (personalized stigma, disclosure
concerns, negative self-image, and concern with public
attitudes about people with HIV). Berger et al. reported an
overall coefficient alpha of .96, a test-retest correlation of
.92, and subscale alphas ranging from .90 to .93. Significant
relationships with several related constructs such as selfesteem (r = -.60), depression (r = .63), and social integration,
(r = .65) established construct validity (Berger et al., 2001).
Both HIV and weight-related stigma are health-related
concerns, providing an appropriate link between the HIV
items and weight-related stigma. Some items required some
wording changes. For example, “Some people act as if it’s
my fault I have HIV” became “Some people act as though
my weight is my fault.” Other items did not require any
wording changes such as “I feel set apart, isolated from the
rest of the world.” Because these wording changes could
affect reliability and validity, we conducted a pilot study to
test the items. After item analysis, 15 items were retained
(see results section for criteria about decisions to reduce
scale items). Participants responded to the 15 Likert-type
statements (1 = strongly disagree to 5 = strongly agree).
Self-Esteem
To measure self-esteem we used the Rosenberg SelfEsteem Scale (Rosenberg, 1965). The 10 Likert-type items (1
= strongly agree to 4 = strongly disagree) assess a person’s
overall evaluation of his or her worthiness as a human being
(Rosenberg, 1979). Rosenberg reported test-retest
correlations (.82 to .88) and Cronbach's alphas (.77 to .88;
see Blascovich & Tomaka, 1993; Rosenberg, 1986).
Photo Profile Manipulation
The development of stimulus materials was loosely based
on Hebl and Turchin (2005). To develop the stimulus
materials,
four
photographs
represented
potential
conversational partners (two obese and two nonobese). The
photographs depicted white females with short to shoulder
length hair who all displayed positive facial expressions in
order to help isolate the influence of weight. Thirty-six
participants responded to an additional page (at the end of
the questionnaire) where they indicated their opinion of the
weight of all four of the pictured women on a Likert-type
scale (1 = very underweight to 5 = very overweight). The
mean scores for the obese photographs were both 4.15 and
for the nonobese photographs were 2.48 and 2.62. Paired
sample t-tests corrected for multiple comparisons using
the Bonferroni correction showed that the two obese
photographs were not perceived as significantly different
(t(35) = 00, p = 1.00), nor were the nonobese photos (t(35)=
.90, p = .373). However, participants perceived the obese
photos as significantly different from the nonobese photos
(t(35) = -17.86, p = .000; t(35) = -14.35, p = .000; t(35) =
13.182; p = .000; t(35) = 14.44, p = .000), demonstrating
validity of the stimulus materials as examples of overweight
and normal weight women.
The same written profile accompanied each of the four
photographs. The profile included the woman’s name (Judy),
her occupation (a schoolteacher), and her age range (between
the ages of 35-45). The profile served to provide depth of
character to the photograph to facilitate answering the
Polk and Hullman
remaining questions in the survey. The characteristics of the
profile were held constant across conditions to isolate the
influence of weight.
Self-Disclosure
To measure self-disclosure we used items developed by
Jourard (1968, 1971a, 1971b). Jourard (1971a, 1971b)
reported satisfactory reliability for several versions. Through
repeated testing, Jourard (1971a) established validity by
showing significant relationships between self-disclosure
and liking and interpersonal attraction. Jourard (1971a)
reported that other researchers have established predictive
validity between past disclosure and willingness to disclose.
In most of the studies, Jourard asked participants either to
check items they would be willing to discuss, or he asked
participants to answer using the following responses: “0 =
have told the other person nothing about this aspect of me,”
“1 = have talked in general terms about this,” “2 = have
talked in full and complete detail about this item to the other
person,” or “X = have lied or misrepresented myself to the
other person so that he has a false picture of me”
(counted/coded as zeros). Participants responded to this
information about one or more specific targets (e.g., mother
or spouse).
Jourard’s (1971b) scale items are topics appropriate to
assess disclosure in this study because of the breadth of
topics they include. For example, items inquire about
hobbies, reading preferences, travel experiences, etc.
Because Jourard asserted that all disclosure is good for
relationship
development
(which
differs
from
communication privacy management), it was important to
get participants to assess their desirability to disclose about
each topic to Judy rather than simply checking their
willingness to disclose to Judy using a Likert-type scale (1 =
highly desirable topic to 5 = highly undesirable topic) ( =
.86). The average for the weight and appearance-related
items were subtracted from the average score for the entire
scale to compute a difference score. The difference score
represents a measure of willingness to disclose weight and
appearance-related items compared against a baseline level
self-disclosure level for the participants.
Attraction
McCroskey and McCain (1974) developed the 15-item
Interpersonal Attraction Scale (IAS) as a three dimensional
construct consisting of social, task, and physical. They
reported internal reliabilities for the 15-item Likert-type
scale (1 = strongly disagree to 7 = strongly agree) ranging
from .81 to .86. Other researchers also have reported
adequate reliability (Wheeless, Frymier, & Thompson,
1992). Construct validity also has been established by Duran
and Kelly (1988) and Burgoon and Hale (1988). For the
purposes of this study, participants responded only to the
five items representing social attraction since the present
study involves a potential friendly conversation (e.g., “I
think she could be a friend of mine.”)
Obesity
To measure obesity, we calculated BMI. According to
the CDC (2009a), BMI is appropriate for this study because
it correlates with most people’s amount of body fat. In the
demographic section, participants completed questions about
Integration and Privacy
The Open Communication Journal, 2011, Volume 5
their height, weight, age, ethnicity, and whether they
participated in a weight/diet-related support group.
Calculating BMI involves weight corrected for height and
has been widely used for assessing weight (Blaine &
Williams, 2004). Other available calculations are more
invasive than participants self-reporting height and weight.
Results ranged from 16.82 to 45.19 (M = 26.04, SD = 6.07).
Nearly 45 % the participants met the BMI criterion reported
by the CDC (2007) for being either overweight (>25) or
obese (>30).
5
internal consistency of the stigma, attraction, and self-esteem
scales. Final items were retained based on the guidelines of
Bentler (1992), Browne and Cudeck, (1993), Hu and Bentler
(1999), and Kline (2005).
Study One
Correlation and regression analysis provided answers to
the hypotheses. Table 1 displays the correlations among the
variables. All relevant analyses account for three different
operational definitions of self-disclosure as a measure of
disclosure of: (a) only weight-related topics, (b) the weightrelated items divided by baseline self-disclosure (adjusted
self-disclosure), and (c) a baseline indicator of how much
participants disclose on a number of topics (baseline selfdisclosure).
To pilot the weight-related stigma items, 114 female
volunteer participants responded to the stigma items and the
Rosenberg Self-Esteem Scale (Rosenberg, 1965). Of the
participants, 46 were undergraduate students and 68 were in
a “mothers of preschoolers” group. Because of some
wording changes, we did not predict a priori that the weightrelated stigma items would produce four factors like the
original measure. An exploratory factor analysis using
principal components analysis helped determine the factor
structure. Although the initial solution produced eight factors
accounting for 75% of the variance, after applying a 60/40
loading rule, a single factor emerged. After eliminating
double loaded items, a 15-item solution accounted for 57%
of the variance. Results suggested sufficient reliability ( =
.96), and validity with a significant negative relationship
with self-esteem (r = -.63, p < .01).
Regression analyses helped answer the first and fifth
hypotheses. The results partially support the first hypothesis,
which predicted that stigma would be a negative predictor of
disclosure. Of the three types of self-disclosure, stigma
served as a negative predictor only for adjusted selfdisclosure (See Tables 2, 3 and 4). Less stigma predicted
more disclosure. The fifth hypothesis centered around the
influence of social attraction on self-disclosure. Attraction
did not significantly predict weight-related self-disclosure or
adjusted self-disclosure (See Tables 2 and 3). However,
social attraction served as a positive predictor of baseline
self-disclosure (See Table 4). This regression also helped to
answer the research question about the role of self-esteem as
a predictor of types of disclosure. Results suggest that selfesteem did not have a significant effect on any of the types
of self-disclosure made in this study (See Tables 2, 3 and 4).
Study Two
For hypotheses two, three, and four, independent sample
t-tests helped answer the predictions. After selecting only to
analyze participants in the normal weight category (BMI <
25), results did not support hypothesis two; that these
participants would engage in less weight-related selfdisclosure to overweight than to normal weight
RESULTS
Reliability analyses suggested sufficient reliabilities for:
weight-related stigma ( = .89), self-esteem ( = .84), overall
self-disclosure ( = .86), and social attraction ( = .77). CFA
using AMOS 6.0 (Arbuckle, 2006) helped to determine the
Table 1.
Correlations Among Variables
Stigma
Photo
BMI
Selfesteem
Attraction
Baseline
SD
Weightrelated SD
Adjusted
SD
Support
Group
Ethnicity
Stigma
1
Photo
.06
1
BMI
.31(**)
.01
1
Self-esteem
-.05
-.13
.04
1
Attraction
-.14(*)
-.04
.05
.04
1
Baseline SD
-.17(*)
-.01
-.01
-.07
.23(**)
1
Weight-related SD
-.13
.04
-.02
-.04
.08
.74(**)
1
Adjusted SD
-.07
.05
-.01
.01
-.07
.29(**)
.85(**)
1
Support Group
-.07
-.01
-.11
-.18(*)
-.11
-.07
-.00
.06
1
Ethnicity
.00
-.14
-.08
-.12
.01
-.08
-.03
.02
.10
1
Age
-.13
-.13
.14
.40(**)
.23(**)
-.02
.04
.07
-.12(**)
-.15(*)
** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).
Age
1
6 The Open Communication Journal, 2011, Volume 5
Table 2.
Polk and Hullman
Regression Analysis for Weight-Related Self-Disclosure
B
SE B
(Constant)
3.331
.763
Age
.002
.005
Ethnicity
-.021
Support group
t
p
4.364
.000
.026
.308
.758
.088
-.019
-.242
.809
-.080
.183
-.034
-.440
.661
Stigma
-.011
.007
-.129
-1.618
.107
BMI
.002
.012
.011
.136
.892
Self-esteem
-.041
.080
-.042
-.522
.603
Attraction
.056
.068
.064
.817
.415
Photo
-.039
.141
-.021
-.279
.781
Note: N = 199
Table 3.
Regression Analysis for Adjusted Self-Disclosure
B
SE B
(Constant)
3.605
.433
Age
-.004
.003
Ethnic
-.064
Support Group
t
p
8.334
.000
-.103
-1.255
.211
.050
-.094
-1.274
.204
-.148
.104
-.106
-1.433
.154
Stigma
-.009
.004
-.168
-2.200
.029
BMI
.002
.007
.025
.330
.742
Self-esteem
-.028
.045
-.048
-.619
.537
Attraction
.120
.039
.234
3.116
.002
Photo
-.079
.080
-.073
-.993
.322
Note: N = 199
conversational partners. More specifically, this prediction
was not true for any of the types of self-disclosure: (a)
baseline self-disclosure = t(101) = 1.78, p = .08 (one-tailed),
M = 3.35, SD = 0.59, (b) weight-related self-disclosure =
t(101) = 0.478, p = .63 (one-tailed), M = 3.03, SD = 0.89 (c)
or adjusted self-disclosure = t(101) = -.378, p = .71(onetailed), M = 0.90, SD = 0.19. Regarding hypothesis three,
that obese participants would be less likely than their normal
weight counterparts to make weight-related self-disclosures
regardless of conversational partner weight, results did not
support this hypothesis for any of the types of selfdisclosure: (a) baseline self-disclosure = t(197) = -0.71, p =
.48 (one-tailed), M = 3.25, SD = 0.60, (b) weight-related selfdisclosure = t(197) = -0.256, p = .80 (one-tailed), M = 2.99,
SD = 0.99 (c) or adjusted self-disclosure (t(101) = 0.023, p =
.98 (one-tailed), M = 0.91, SD = 0.22. Hypothesis four
predicted that regardless of participant weight, obese
conversational partners would be rated as less socially
attractive than nonobese conversational partners. Results did
not support this hypothesis (t(197) = 0.57, p = .57 (onetailed), M = 5.30, SD = 0.99).
DISCUSSION
In the present investigation, we sought to determine the
effects of weight-related stigma on women’s self-disclosure
patterns using communication privacy management as a
framework. As Petronio (2000; 2002) explained, privacy is
actually a dialectical tension balanced by self-disclosure.
People can make attempts to suppress the saliency of weightrelated appearance by avoiding certain conversational topics.
If someone feels the need to keep weight information
private, s/he most likely will avoid those topics in
conversation. Ironically, disclosing the information could be
one way to reduce weight-related stigma (Puhl & Brownell,
2003).
The reason for avoiding these topics most likely stems
from weight-related stigma. Both Limandri (1989) and
Herek and Glunt (1988) claimed that stigma results in a
Integration and Privacy
Table 4.
The Open Communication Journal, 2011, Volume 5
7
Regression Analysis for Baseline Self-Disclosure
B
SE B
(Constant)
.915
.174
Age
.002
.001
Ethnicity
.011
Support group
t
p
5.271
.000
.111
1.292
.198
.020
.041
.535
.594
.017
.042
.032
.413
.680
Stigma
-.001
.002
-.072
-.902
.369
BMI
.000
.003
.012
.149
.882
Self-esteem
-.001
.018
-.003
-.039
.969
Attraction
-.018
.015
-.090
-1.144
.254
Photo
.004
.032
.010
.136
.892
Note: N = 199
preference for avoidance because it carries shame and
discredit. In the case of weight-related stigma, both normal
weight and overweight individuals hold implicit stereotypes
that those who are obese are lazy and bad (Schwartz et al.,
2006). The same sample also reported a willingness to make
sacrifices (e.g., their fertility) rather than be obese. Perhaps
those who feel weight-related stigma internalize weight and
appearance so much so that it engulfs their identity.
Sontag (1989) argued that having a chronic illness
changes a person’s identity. As a result, disclosure leads to
feelings of vulnerability and may result in self-identity
protection rules. The finding that stigmatized individuals
prefer to talk about non-weight-related topics over weightrelated topics supports this argument.
These feelings seem counterbalanced by attraction to
their conversational partner. Attitudes of potential friendship
and social attraction resulted in more disclosure. These
findings support Altman and Taylor’s (1973) claims that
people rate relationships more favorably and will progress to
the next level when they forecast future rewards. For those
who feel weight-related stigma, attraction toward others
provides avenues for interpersonal support, even from those
who do not have weight issues themselves.
Overweight or obese people tend to be more critical of
others who are overweight or obese than people in a normal
weight range (Brown & Thompson, 2007). As a result, these
avoidance attempts are true even with in-group members,
who normally would be a source of information sharing and
support. Thus, people who are overweight themselves would
be likely to avoid disclosing information about weight to
maintain privacy and control. However, the target of
disclosure’s weight did not elicit a difference in selfdisclosure patterns.
The lack of significance might suggest that these prior
findings of negative attributions and criticism are not always
founded. People seem at least still willing to engage in
conversation and to self-disclose, despite the other person’s
physical appearance. As a result, this study provides some
related evidence to support the idea that people’s weight
does not negatively impact the quality of the interpersonal
relationships (Carr & Friedman, 2006).
Level of self-esteem also does not seem to influence
willingness to disclose weight-related information. Despite
reason to believe that self-esteem influences disclosure
choices about failures (Cameron et al., 2009), we did not
also assess whether participants deemed their weight as a
personal failure. Perhaps it was not considered a personal
failure for our participants, whose scores for self-esteem
were unrelated to scores for weight-related stigma.
Aside from support for communication privacy
management for self-disclosure patterns of weight-related
information, the current investigation also provides a
promising new measure for weight-related stigma. Given the
growing problem of obesity in society and the need for social
support for those dealing with weight-related stigma, future
research addressing this issue is imminent. The stigma
measure we adapted from the HIV stigma measure (Berger et
al., 2001) provides a standardized measure with acceptable
psychometric properties for future research.
Limitations
As with all studies, some limitations should be noted. For
example, the four photographs used were uncopyrighted
internet photos of four different women. Even though the
manipulation check established that participants judged
correctly the photos intended to represent nonobese women
and obese women, participants’ answers could not be
attributed wholly to weight assessments. Perhaps taking one
photograph of the same nonobese woman and manipulating
it to make her appear obese (or vice versa) would strengthen
the study.
In addition, all methodologies involve trade-offs. In this
study, some limitations of using self-reported data should be
acknowledged. First, it is possible that participants lied about
their weight; however, this seemed less invasive than
weighing participants and measuring their height. Second,
having participants self-report about “Judy” could be very
8 The Open Communication Journal, 2011, Volume 5
different from their actual behavior, so future research could
involve actual interactions.
CONCLUSION
Whereas this study only measured the topics that people
selected they would be willing to discuss, future research
could focus on the reasons people give for their disclosure
decisions. Derlega et al.’s (1998) study about people with
HIV revealed 11 different reasons for disclosing HIV status
as well as seven reasons for keeping HIV status private.
Even though weight is not concealable, people can exercise
control over weight-related topics. Future studies might
uncover the reasons people who are obese cite for their
disclosure decisions.
In addition, future research could focus on the actual
language used in conversation. Because Brown and
Thompson (2007) found that nurses showed particular
sensitivity to word choices about weight-related issues, it is
possible that other people use different language when they
discuss weight-related issues depending on their own and
their interaction partner’s weight. Smith, Waldorf, and
Trembath (1990) suggested that terms such as voluptuous
and full-figured are attempts to develop more positive
thinking about larger women, and it is possible that
differences exist depending on the terminology utilized.
Finally, research suggests that whereas women are held
to more rigid standards for weight and appearance, many
men increasingly experience weight-related stigma (Hebl &
Turchin, 2005). Including men in future studies also should
be a consideration for future research.
Obesity is a hot button topic right now. Health experts
are attempting to address the issue by educating the public
about nutrition choices and activity levels. However, the
prevalence of weight-related stigma clearly affects how
people think about obesity which, in turn, affects how people
talk about weight-related issues. Barriers to disclosure may
occur when people experience stigma. These barriers
suppress information sharing and support. This issue
becomes more problematic when people within an in-group
stigmatize other in-group members more harshly than outgroup members. Learning more about the nature of weightrelated communication topics is an essential component to
providing people with tools to make the changes necessary
to lose weight successfully and to maintain a healthy weight.
DISCLOSURE
An earlier version of this manuscript was presented at the
2008 National Communication Association Convention.
REFERENCES
Afifi, T. D. (2003). “Feeling caught” in stepfamilies: Managing boundary
turbulence through appropriate communication privacy rules.
Journal of Social and Personal Relationships, 20, 729-755.
Afifi, W. A., & Caughlin, J. P. (2009). A close look at revealing secrets and
consequences that follow. Communication Research, 33, 467-488.
Altman, I., & Taylor, D. (1973). Social Penetration: The Development of
Interpersonal Relationships. New York: Holt, Rinehart and
Winston.
Arbuckle, J. L. (2006). AMOS (Version 6.0) [Computer software]. Chicago:
SmallWaters Corporation.
Polk and Hullman
Barker, B. L., & Benton, C. L. (1994). The Ethics of Feminist Selfdisclosure. In Carter K. & Presnell M. (Eds.), Interpretive
Approaches to Interpersonal Communication (pp. 219-246).
Albany, NY: State University of New York Press.
Bentler, P. M. (1992). On the fit of models to covariances and methodology
to the bulletin. Psychological Bulletin, 112, 400-404.
Berg, J. H., & Archer, R. L. (1983). The disclosure-liking relationship:
Effects of self-perception, order of disclosure, and topical
similarity. Human Communication Research, 10, 269- 281.
Berger, B. E., Ferrans, C. E., & Lashley, F. R. (2001). Measuring stigma in
people with HIV: Psychometric assessment of the HIV stigma
scale. Research in Nursing & Health, 24, 518-529.
Bidgood, J., & Buckroyd, J. (2005). An exploration of obese adults’
experience of attempting to lose weight and to maintain a reduced
weight. Counseling and Psychotherapy Research, 5, 221-229.
Blaine, B., & Williams, Z. (2004). Belief in the controllability of weight and
attributions to prejudice among heavyweight women. Sex Roles,
51, 79-84.
Blascovich, J., & Tomaka, J. (1993). Measures of self-esteem. In Robinson,
J. P., Shaver, P. R., & Wrightsman, L. S., (Eds.), Measures of
Personality and Social Psychological Attitudes (3rd ed., pp. 115160). Ann Arbor: Institute for Social Research.
Bliss, K. (2006). Redefine the problem so it has a solution. Health at Every
Size, 20, 17-23.
Boyes, A. D., & Latner, J. D. (2009). Weight stigma in existing romantic
relationships. Journal of Sex and Marital Therapy, 35, 282-293.
Broder, S. (1982). Liking, own disclosure, and partner disclosure in female
roommates. Journal of Social Psychology, 117, 303-304.
Brown, I., & Thompson, J. (2007). Primary care nurses’ attitudes, beliefs,
and own body size in relation to obesity management. Journal of
Advanced Nursing, 60, 535, 543.
Browne, M. W., & Cudek, R. (1989). Single sample cross-validation indices
for covariance structures. Multivariate Behavioral Research, 24,
445-455.
Burgoon, J. K., & Hale, J. L. (1988). Nonverbal expectancy violations:
Model elaboration and application to immediacy behaviors.
Communication Monographs, 55, 58-79.
Cameron, J. J., Holmes, J. G., Vorauer, J. D. (2009). When self-disclosure
goes awry: Negative consequences of revealing personal failures
for lower self-esteem individuals. Journal of Experimental Social
Psychology, 45, 217-222.
Carr, D., & Friedman, M. A. (2006). Body weight and the quality of
interpersonal relationships. Social Psychology Quarterly, 69, 127149.
Caughlin, J. P., Huston, T. L., & Houts, R. M. (2000). How does personality
matter in marriage? An examination of trait anxiety, interpersonal
negativity, and marital satisfaction. Journal of Personality & Social
Psychology, 78, 326-336.
Center for Disease Control. (2007). BMI – Body mass index. Retrieved February, 12, 2008 from http://www.cdc.gov/nccdphp/dnpa/bmi/adult_BMI/about_adult_BMI.htm#Interpreted
Center for Disease Control and Prevention (2009a). Overweight and obesity.
Retrieved
January
28,
2009
from
http://www.cdc.gov/nccdphp/dnpa/obesity/defining.htm
Center for Disease Control and Prevention (2009b). Overweight and
obesity. Retrieved August 20, 2009 from http://www.cdc.gov/obesity/data/trends.html
Chen, N. Y. (1997). On physical attractiveness stereotyping in Taiwan: A
revised sociocultural perspective. Journal of Social Psychology,
137, 117-124.
Crandall, C. S. (1994). Prejudice against fat people: Ideology and selfinterest. Journal of Personality and Social Psychology, 66, 882894.
Crocker, J., Voelkl, K., Testa, M., & Major, B. (1991). Social stigma: The
affective consequences of attributional ambiguity. Journal of
Personality and Social Psychology, 60, 218-228.
Derlega, V. J., Lovejoy, D., & Winstead, B. A. (1998). Personal Accounts
on Disclosing and Concealing HIV-Positive Test Results:
Weighing the Benefits and Risks. In Derlega, V. J., & Barbee, A.
P., (Eds.), HIV and Social Interaction (pp. 147-164). Thousand
Oaks, CA: Sage.
Delerga, V. J., Metts, S., Petronio, S., & Margulis, S. T. (1993). SelfDisclosure. Thousand Oaks, CA: Sage.
Dindia, K. (1994). The Intrapersonal-Interpersonal Dialectical Process of
Self-Disclosure. In Duck, S., (Ed.), Dynamics of Relationships (pp.
27-57). Thousand Oaks, CA: Sage.
Integration and Privacy
Dindia, K., & Allen, M. (1992). Sex-differences in self-disclosure: A metaanalysis. Psychological Bulletin, 112, 106-124.
Dolgin, K. G., Meyer, L., & Schwartz, J. (1991). Effects of gender, target’s
gender, topic, and self-esteem on disclosure to best and midling
friends. Sex Roles, 25, 311-329.
Duran, R. L., & Kelly, L. (1988). The influence of communicative
competence on perceived tasks, social, and physical attraction.
Communication Quarterly, 36, 41-49.
Durso, L. E., & Latner, J. D. (2008). Understanding self-directed stigma:
Development of the weight bias internalization scale. Obesity, 16,
S80-6.
Duval, S., & Wicklund, R. A. (1972). A Theory of Objective SelfAwareness. New York: Academic Press.
Friedman, K. E., Reichmann, S. K., Costanzo, P. R., Zell, A., Ashmore, J.
A., & Musante, G. J. (2005). Weight stigmatization and ideological
beliefs: Relation to psychological functioning in obese adults.
Obesity Research, 13, 907-916.
Goffman, E. (1963). Stigma. Englewood Cliffs, NJ: Prentice-Hall.
Goldsmith, D. (2004). Communicating Social Support. Cambridge, UK:
Cambridge University Press.
Greene, K. (2000). Disclosure of Chronic Illness Varies by Topic and
Target: The Role of Stigma and Boundaries in Willingness to
Disclose. In Petronio, S., (Ed.), Balancing the Secrets of Private
Disclosures (pp. 123-135). Mahwah, NJ: Erlbaum.
Greene, K., Derlega, V. J., Yep, G. A., & Petronio, S. (2003). Privacy and
Disclosure of HIV in Interpersonal Relationships: A Sourcebook
for Researchers and Practitioners. Mahwah, NJ: LEA Publishers.
Harris, R. M., & Dewdney, P. (1994). Barriers to Information: How Formal
Help Systems Fail Battered Women. Westport, CT: Greenwood
Press.
Hebl, M. R., & Mannix, L. M. (2003). The weight of obesity in evaluating
others: A mere proximity effect. Personality and Social Psychology
Bulletin, 29, 28-38.
Hebl, M. R., & Turchin, J. M. (2005). The stigma of obesity: What about
men? Basic and Applied Social Psychology, 27, 267-275.
Herek, G. M., & Glunt, E. K. (1988). An epidemic of stigma: Public
reactions to AIDS. American Psychologist, 43, 886-891.
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in
covariance structure analysis: Conventional criteria versus new
alternatives. Structural Equational Modeling: A Multidisciplinary
Journal, 6, 1-55.
Jacoby, A. (2005). Epilepsy and social identity: The stigma of a chronic
neurological disorder. Lancet Neurology, 4, 171-178.
Jourard, S. M. (1964). The Transparent Self: Self-Disclosure and WellBeing. New York: Van Nostrand Reinhold.
Jourard, S. M. (1968). Disclosing Man to Himself. New York: Van Nostrand
Reinhold Company.
Jourard, S. M. (1971a). Self-disclosure: An Experimental Analysis of the
Transparent self. New York: Wiley.
Jourard, S. M. (1971b). The transparent self (Rev ed.). New York: Van
Nostrand Reinhold.
Kline, R. B. (2005). Principles and Practice of Structural Equation
Modeling (2nd ed.). New York: Guilford.
Knapp, M. L., & Hall, J. A. (1997). Nonverbal Communication in Human
Interaction (4th ed.). Fort Worth, TX: Harcourt Brace.
Legenbauer, T., Vocks, S., Shäfer, C. Schütt-Stromel, S., Hiller, W.,
Wagner, C., & Vogele, C. (2009). Preference for attractiveness and
thinness in a partner: Influence of internalization of the thin ideal
and shape/weight dissatisfaction in heterosexual women,
heterosexual men, lesbians, and gay men. Body Image, 6, 228-234.
Lewis, S. T., & Van Puymbroeck, M. (2008). Obesity-stigma as a
multifaceted constraint to leisure. Journal of Leisure Research, 40,
574-588.
Limandri, B. J. (1989). Disclosure of stigmatizing conditions: The
discloser’s perspective. Archives of Psychiatric Nursing, 3, 69-78.
Lin, C. A. (1998). Use of sex appeals in prime-time television commercials.
Sex Roles, 38, 461-475.
McCroskey, J. C., & McCain, T. A. (1974). The measurement of
interpersonal attraction. Speech Monographs, 41, 261-266.
Metzger, M. J. (2007). Communication privacy management in electronic
commerce. Journal of Computer-Mediated Communication, 12, 127.
Miller, G. T., & Downey, K. T. (1999). A meta-analysis of heavyweight and
self-esteem. Personality and Social Psychology Review, 5, 68-84.
Morr Serewicz, M. C., & Petronio, S. (2007). Communication Privacy
Management Theory. In Whaley, B., & Samter, W., (Eds.),
The Open Communication Journal, 2011, Volume 5
9
Explaining Communication: Contemporary Theories and
Exemplars (pp. 257-273). Mahwah, NJ: Lawrence Erlbaum
Associates.
Myers, A., & Rosen, J. C. (1999). Obesity stigmatization and coping:
Relation to mental health symptoms, body image, and self-esteem.
International Journal of Obesity, 23, 221-230.
Okun, M.A., & Keith, V. M. (1998). Effects of positive and negative social
exchanges with various sources on depressive symptoms of
younger and older adults. Journals of Gerontology: Series B:
Psychological Sciences and Social Sciences, 53, 4-20.
Panchankis, J. E. (2007). The psychological implications of concealing a
stigma: A cognitive–affective–behavioral model. Psychological
Bulletin, 133, 328-345.
Petronio, S. (1991). Communication boundary management: A theoretical
model of managing disclosure of private information between
marital couples. Communication Theory, 1, 311-335.
Petronio, S. (2000). The Boundaries of Privacy: Praxis of Everyday Life. In
Petronio, S., (Ed.), Balancing the Secrets of Private Disclosures
(pp. 37-50). Mahwah, NJ: Erlbaum.
Petronio, S. (2002). The Boundaries of Privacy: Dialectics of Disclosure.
New York: State University of New York Press.
Petronio, S. (2007). Translational research endeavors and the practices of
communication privacy management. Journal of Applied
Communication Research, 35, 218-222.
Petronio, S., & Kovach, S. (1997). Managing privacy boundaries: Health
providers’ perceptions of resident care in Scottish nursing homes.
Journal of Applied Communication Research, 25, 115-131.
Puhl, R. M., & Brownell, K. D. (2003). Psychosocial origins of obesity
stigma: Toward changing a powerful and pervasive bias. Obesity
Reviews, 4, 213-227.
Puhl, R. M., & Heuer, C. A. (2009). The stigma of obesity: A review and
update. Obesity, 17, 941-964.
Quinn, D. M., & Crocker, C. (1999). When ideology hurts: Effects of belief
in the Protestant ethic and feeling overweight on the psychological
well-being of women. Journal of Personality and Social
Psychology, 77, 402-414.
Rogge, M. M., Greenwald, M., & Golden, A. (2004). Obesity, stigma, and
civilized oppression. Advances in Nursing Science, 27, 301-315.
Rosenberg, M. (1965). Society and the Adolescent Self-Image. Princeton,
NJ: Princeton University Press.
Rosenberg, M. (1979). Conceiving the Self. New York: Basic Books.
Rosenberg, M. (1986). Self-Concept from Middle Childhood Through
Adolescence. In Suls, J., & Greenwald, A. G., (Eds.),
Psychological Perspectives on the Self (Vol. 3, pp. 107-135).
Hillsdale, NJ: Erlbaum.
Rubin, Z., Hill, C. T., Peplau, L. A., & Dunkel-Schetter, C. (1980). Selfdisclosure in dating couples: Sex roles and the ethic of openness.
Journal of Marriage and the Family, 42, 305-317.
Scheyett, A. (2005).The mark of madness: Stigma, serious mental illness,
and social work. Social Work in Mental Health: The Journal of
Behavioral and Psychiatric Social Work, 3, 79-97.
Schwartz, M. B., Vartanian, L. R., Nosek, B. A., & Brownell, K. D. (2006).
The influence of one’s own body weight on implicit and explicit
anti-fat bias. Obesity, 14, 440-447.
Shapiro, J. R., King, E. B., & Quinones, M. A. (2007). Expectations of
obese trainees: How stigmatized trainee characteristics affect
trainee effectiveness. Journal of Applied Psychology, 92, 239-249.
Smith, C. A., Schmoll, K., Konik, J., & Oberlander, S. (2007). Carrying
weight for the world: Influence of weight descriptors on judgments
of large-sized women. Journal of Applied Social Psychology, 5,
989-1006.
Smith, J. E., Waldorf, V. A., & Trembath, D. L. (1990). “Single white male
looking for thin, very attractive . . . ” Sex Roles, 23, 675–685.
Sontag, S. (1989). Illness as Metaphor; and, AIDS and its Metaphors. New
York: Anchor Books Doubleday.
Teachman, B., Gapinski, K. D., Brownell, K. D., Rawlins, M., & Jeyaram,
S. (2003). Demonstrations of implicit anti-fat bias: The impact of
providing causal information and evoking empathy. Health
Psychology, 22, 68-78.
Thorson, A. R. (2009). Adult children’s experiences with their parent’s
infidelity: Communication protection and access rules in the
absence of divorce. Communication Studies, 60, 32-48.
Tucker, K. L., Martz, D. M., Curtin, L. A., & Bazzini, D. G. (2007).
Examining “fat talk” experimentally in a female dyad: How are
women influenced by another woman’s body presentation style?
Body Image, 4, 157-164.
10 The Open Communication Journal, 2011, Volume 5
Polk and Hullman
Wadden, T. A., & Didle, E. (2003). What’s in a name? Patients’ preferred
terms for describing obesity. Obesity Research, 11, 1140-1146.
Warner, D., & Procaccino, J. D. (2004). Toward wellness: Women seeking
health information. Journal of the American Society for
Information Science and Technology, 55, 709-730.
Wheeless, L. R., Frymier, A. B., & Thompson, C. A. (1992). A comparison
of verbal output and receptivity in relation to attraction and
Received: September 01, 2010
communication satisfaction in interpersonal relationships.
Communication Quarterly, 38, 372-387.
Wilson, L. L., Roloff, M. E., & Carey, C. M. (1998). Boundary rules:
Factors that inhibit expressing concerns about another's romantic
relationship. Communication Research, 25, 618-640.
Wuest, J. (2000). Negotiating with helping systems: An example of
grounded theory evolving through emergent fit. Qualitative Health
Research, 10, 51-70.
Revised: November 29, 2010
Accepted: December 03, 2010
© Polk and Hullman.; Licensee Bentham Open.
This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.